HomeMy WebLinkAboutPAINT YOUR HEART OUT (CDBG)City of Santa i ,a
Clerk of the Coui.,Al
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AGREEMENT TERMINATION
Make sure to include all
amendments if any.
Please complete this form when the attached agreement is no longer in effect.
Return form to the Clerk of the Council Office (M-30).
Call 647-2520 if you have any questions.
The agreement with
No. A-ZAai -aqj-cl z was completed on d,-30 - 16
and final payment has been made.
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Signature:
Date: gr
Revised 05-04-08
INSURANCE ON FILE
WORK MAY PROCEED A-2009-043-012
UNTIL INSURANCE EXPIRES
CLERK OF COUNCIL
neTF: SEP 1 6 Z009 5/05
AGREEMENT BETWEEN THE CITY OF SANTA ANA AND
PAINT YOUR HEART OUT, INC FOR USE OF
COMMUNITY DEVELOPMENT BLOCK GRANT FUNDS
(With Provisions Relating to Compliance with Title X
and 24 CFR Part 35 Relating to Lead Based Paint)
This Agreement, made and entered into this 1st day of July, 2009, by and between the City
of Santa Ana, a charter cly and municipal corporation of the State of California ("CITY") and
; a California nonprofit corporation ("SUBRECIPIENT"),
J
I WITNESSETH
!ti 1 Recitals:
CJ
0 �) A. The CITY, as an entitlement recipient and grantee of the United States Department of
Housing and Urban Development ("HUD") Community Development Block Grant ("CDBG")
Program, desires to enter this Agreement with the SUBRECIPIENT for the expenditure of CDBG
funds in accordance with Title 24, Part 570 of Code of Federal Regulations 24 CFR 570.000, et seq.
("CDBG REGS"); and
B. CITY has applied for and received CDBG funds from HUD pursuant to Title I of the
Housing and Community Development Act of 1974, Public Law 93-383, as amended ("ACT"); and
C. The SUBRECIPIENT is a private nonprofit agency that has been selected by the CITY to
receive CDBG funds and administer such financial assistance; and to provide the services described
in Exhibit A, in accordance with the schedule of performance included therein, hereinafter referred
to as "said program". SUBRECIPIENT represents that it is qualified and willing to operate said
program and certifies that the activities carved out with funds provided under this Agreement will
meet one or more of the CDBG program's National Objectives (24 CFR Part 570.208).
D. SUBRECIPIENT agrees that it will adhere to the performance measurements and
outcomes as indicated on Exhibit A -I ("Outcome Tracking"). Failure to follow the
measurements and meet the stated outcomes may constitute breach of contract that could result
in termination of this Agreement or serve as reason for the City to recapture the grant funds
awarded to SUBRECIPIENT pursuant to this Agreement.
E. Title X of the 1992 Housing and Community Development Act (Title X) established
requirements relating to lead based paint ("LBP") in housing receiving federal assistance,
in particular requirements relating to (i) notification (including pamphlet distribution, disclosure to
purchasers and lessees, notice of lead hazard presumption or results of evaluation, and/or lead
hazard reduction), (ii) lead hazard evaluation (including visual assessment, paint testing, and/or risk
assessment), (iii) lead hazard reduction (including paint stabilization, interim controls, standard
treatments, or abatement depending on the requirements for housing activity type), (iv) ongoing
maintenance, if required, and (v) response to children with environmental intervention blood lead
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levels, as required; and
F. On September 15, 1999 HUD adopted implementing regulations to Title X that became
effective September 15, 2000 as set forth in 24 CFR Part 35, et seq. ("LBP Regs"), which establish
specific rules regarding notification to owners and occupants about the existence of LBP hazards,
identification of LBP hazards, and control of LBP hazards; and
G. Residential structures built after January 1, 1978 are exempt from lead -based paint
requirements as the use of lead -based paint was banned for use in residences after this date by
Congress (24 CFR Part 35.115). Therefore, the Title X requirements set forth herein shall not be
applicable if the structures involved were built after January 1, 1978.
H. Subpart K - Acquisition, Leasing, Support Services, and Operation of the LBP Regs,
sets forth specific requirements relating to housing providers, such as SUBRECIPIENT, who
administer local programs that provide supportive housing for special needs populations and are
funded by HUD Office of Community Planning and Development ("CPD") programs, including
CDBG funds, as provided to SUBRECIPIENT under this Agreement; and
I. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and evidence of compliance with all applicable requirements of Title X
and the LBP Regs, in particular Subpart K relating to acquisition, leasing, support services, or
operations, and Subpart J relating to rehabilitation, as and when applicable; and
J. In connection with the grant of funds under this Agreement, CITY requires that
SUBRECIPIENT comply and show evidence of compliance with all applicable requirements of
Title X and the LBP Regs, in particular Subpart M relating to tenant based rental assistance, as and
when applicable; and
K. Attached and hereby fully incorporated to this Agreement are the following notification
attachments: Attachment No. 1 entitled "Protect Your Family From Lead In Your Home",
EPA747-K-99-001, Attachment No. 2 entitled "Sample Disclosure Format for Target Housing
Sales, Disclosure of Information on Lead -Based Paint and Lead -Based Paint Hazards", and
Attachment No. 3 entitled Sample Summary Risk Assessment Notice Format"; provided however,
that such attachments are not intended to modify or limit SUBRECIPIENT'S obligation to fully
comply with all applicable provisions of Title X and the implementing regulations in the LBP Regs;
and
L. By this Agreement SUBRECIPIENT will accept assignment from the CITY of all
responsibilities set forth in Subpart K of the LBP Regs; and
M. The CITY and SUBRECIPIENT have duly executed this Agreement for the expenditure
of such funds; and
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WHEREFORE, it is agreed by and between the parties, that the foregoing Recitals are a substantive
part of this Agreement and the following terms and conditions are approved and together with all
exhibits and attachments hereto, shall constitute the entire Agreement between the CITY and
SUBRECIPIENT:
L SUBRECIPIENT'S OBLIGATIONS
A. Non -Profit Status - RMresentations and Warranties.
(1) SUBRECIPIENT acknowledges that its operations and the services it provides to the
community are subject to Subpart K (and, in some instance(s) Subpart J and/or Subpart M) of the
LBP Regs.
(2) SUBRECIPIENT acknowledges that its operations and the services it provides
includes: (a) acquisition, leasing, or ownership of residential property for the purpose of
providing affordable housing for persons with special needs, such as transitional housing, or
(b) housing for persons with special needs, such as the disabled, or (c) financial assistance to
assist transitional housing participants to move to permanent housing by paying for the first
month's rent or security deposit, or (d) tenant -based rental assistance to program participants
who choose their own housing units, and by provision of such services such housing is subject to
the requirements of the LBP Regs.
(3) Representations:
(a) Authority. SUBRECIPIENT is a duly organized and existing non-profit
corporation in good standing and authorized to do business under the laws of the State of
California. SUBRECIPIENT has full right, power and lawful authority to accept the funding
hereunder and to undertake all obligations as provided herein and the execution, performance
and delivery of this Agreement by SUBRECIPIENT has been fully authorized by all requisite
actions on the part of SUBRECIPIENT.
(b) Experience. SUBRECIPIENT is a qualified provider of the services to be
provided hereunder.
(c) Familiarity With Services Required. By executing this Agreement,
SUBRECIPIENT warrants that (i) it has thoroughly investigated and considered the services to
be performed and provided hereunder, (ii) it has carefully considered how the services should be
performed, and (iii) it fully understands the facilities, difficulties and restrictions attending
performance of the services under this Agreement, inclusive of compliance with the LBP REGS.
Should SUBRECIPIENT discover any latent or unknown conditions materially differing from
those inherent in the work or as represented by CITY, it shall immediately inform CITY of such
fact and shall not proceed except at SUBRECIPIENT'S risk until written instructions are
received from CITY'S representative.
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(d) No Conflict. To the best of SUBRECIPIENT'S knowledge,
SUBRECIPIENT'S execution, delivery and performance of its obligations under this Agreement
will not constitute a default or a breach under any contract, agreement or order to which
SUBRECIPIENT is a parry or by which it is bound.
(e) No Bankruptcy. SUBRECIPIENT is not the subject of any current or
threatened bankruptcy proceeding.
(f) No Pending Legal Proceedings. SUBRECIPIENT is not the subject of a
current or threatened litigation that would or may materially affect SUBRECIP)ENT'S
performance under this Agreement.
(g) Application Veracity. All provisions of and information provided in
SUBRECIPIENT'S application for funding submitted to CITY including any exhibits are true
and correct in all material respects.
(h) No Pending Investigation. SUBRECIPIENT is not aware that it is the
subject of any current or threatened criminal or civil action investigation by any public agency,
including without limitation a police agency or prosecuting authority, that would relate to affect
performance of the Agreement or provision of services hereunder.
(4) Compliance with Subpart K of LBP Rees. Subpart K — Acquisition,
Leasing, Support Services, or Operation
(a) SUBRECIPIENT acknowledges and agrees that it shall comply with and
implement the requirements set forth in Title X and the LBP Regs to eliminate, as far as
practicable, LBP hazards in all residential property that is under its ownership, possession, or
control and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(b) SUBRECIPIENT shall provide a notice to all residents/occupants of
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT
in accordance with Section 35.12E of the LBP Regs.
(i) SUBRECIPIENT acknowledges that in connection therewith a visual
assessment is not considered an evaluation for purposes of the LBP Regs.
(c) Notification (24 CFR 35.130). SUBRECIPIENT shall provide the LBP
hazard information pamphlet in accordance with Section 35.130 of the LBP Regs to all
occupants, owners, and purchasers of housing.
(i) The pamphlet shall be the EPA/HUD/Consumer Product
Safety Commission lead hazard information pamphlet or an EPA -approved
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equivalent. The current form and version of the pamphlet is attached as
Attachment No. I to this Agreement.
(ii) SUBRECIPIENT shall cause to be disclosed to all purchasers
and lessees available information and knowledge regarding the presence of LBP
and LBP hazards prior to selling or leasing a housing unit in accordance with 24
CFR 35, Subpart A. The current form and version of such notice is attached as
Attachment No. 2 to this Agreement.
(iii) SUBRECIPIENT shall ensure that all occupants, owners, and
purchasers of housing be notified in writing of the results of the presumption of
LBP and/or LBP hazards, and results of any lead hazard evaluation, and any lead
hazard reduction work in accordance with 24 CFR 35, Subpart A. The current
form and version of such notice is attached as Attachment No. 3 to this
Agreement.
(d) Lead Hazard Evaluation (24 CFR 35.125I. SUBRECIPIENT shall conduct
all activities described in Section 35.1015 relating to visual assessment, paint stabilization, risk
assessment, and maintenance with regard to all residential property that is under its ownership,
possession, or control and/or residential property occupied by persons or families that receive
financial or other assistance from SUBRECIPIENT, except for the exemptions described below
in section 4 (d)(i)(1).
(i) SUBRECIPIENT shall cause a visual assessment to identify
deteriorated paint in all residential property that is under its ownership, possession, or control
and/or residential property occupied by persons or families that receive financial or other
assistance from SUBRECIPIENT.
(1)Section 35.115(a) provides exemptions from Subparts B
through R of the LBP Regs including without limitation, (a) short term emergency assistance
lasting less than 100 days cumulatively is exempted from compliance with Subpart K as to such
short term rental assistance units, and (b) exemption for zero -bedroom units, including SRO
units, for which occupancy by a recipient of SUBRECIPIENT'S services is for less than 100
days, and (c) exemption for residential housing units constructed after January 1, 1978.
(ii) To the extent that the assistance provided by SUBRECIPIENT
to persons or households meets one or more of the exemptions set forth in the LBP Regs, then
compliance with the notification, evaluation, reduction, clearance and other requirements of the
LBP Regs is not required related to the subject housing unit due to such exemption.
(iii) SUBRECIPIENT shall comply with the applicable provisions
of both Subpart K and Subpart M (Tenant Based Rental Assistance) of the LBP Regs as to all
tenant -based long term housing assistance, i.e., assistance to persons/households residing in
housing units cumulatively for more than 100 days. If SUBRECIPIENT has knowledge that an
assisted family or household will occupy a dwelling unit for more than 100 days, the LBP Regs
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require evidence of compliance prior to occupancy. Funding to be provided hereunder is
conditioned upon evidence of compliance.
(1) Subpart M applies to all dwelling units occupied to be
occupied by families or households that have one or more children of less than 6 years of age, as
well as the common areas servicing such dwelling units, and exterior painted surfaces associated
with such dwelling units or common areas. LBP compliance requirements relating to such
dwelling units includes, without limitation: notification, evaluation by visual assessment, paint
stabilization utilizing safe work practices, and clearance.
(2) CITY advises SUBRECIPIENT that in the event the
services provided hereunder include rental assistance payments, such as first and last month's
rent and/or security deposit, and the assisted tenant executes a lease for long term occupancy,
including occupancy in the same dwelling unit for more than 100 days, then the provisions of
Subpart M (Tenant Based Rental Assistance), will apply (unless otherwise informed and directed
by HUD). In this regard, CITY advises SUBRECIPIENT that Subpart M requires HQS
inspection of each dwelling unit prior to occupancy and prior to compliance with applicable
notification, evaluation by visual assessment, reduction through paint stabilization utilizing safe
work practices, and clearance requirements of the LBP REGS.
(e) Lead Hazard Reduction Work. SUBRECIPIENT shall cause LBP hazard
reduction, such as paint stabilization, interim controls, standard treatments, or abatement of all
residential property that is under its ownership, possession, or control and/or residential property
occupied by persons or families that receive financial or other assistance from SUBRECIPIENT,
except as exempted as described in subsection 4(d)(i)(1) above.
(1) If paint stabilization occurs, SUBRECIPIENT shall cause paint
stabilization of each deteriorated surface and clearance of residential units pursuant to Section
35.1330(a) and (b) shall occur before occupancy of a vacant dwelling unit, or where a unit is
occupied, immediately after receipt of the CDBG FUNDS hereunder.
(2) Safe Work Practices shall be used in all LBP hazard reduction work.
(3) Clearance shall be conducted to confirm that no LBP hazards remain
when LBP hazard reduction work is complete. Confirmation of clearance by written certification
of a qualified inspector is required on an annual basis in connection with submittal of the April
15 quarterly report.
(f) Ongoing Maintenance. SUBRECIPIENT shall incorporate ongoing LBP
maintenance activities into regular building operations in accordance with Section 35.1355(a) for
all residential property that is under its ownership, possession, or control and/or residential
property occupied by persons or families that receive financial or other assistance from
SUBRECIPIENT, except as exempted as described in subsection 4(d)(i)(1) above.
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(1) Ongoing maintenance includes confirmation of clearance which shall
be conducted to confirm that no LBP hazards remain when LBP hazard reduction work is
complete.
(2) Ongoing maintenance also includes confirmation of clearance by
written certification of a qualified inspector on an annual basis in connection with submittal of
the April 15 quarterly report.
(3) A part of such ongoing maintenance obligation includes notification of
the results of clearance confirmation and annual confirmation of clearance.
a. SUBRECIPIENT shall cause to be provided a notice to all
occupants of all residential property that is under its ownership, possession, or control and/or
residential property occupied by persons or families that receive financial or other assistance
from SUBRECIPIENT in accordance with Sections 35.125(b)(1) and (c), describing the results
of the clearance examination and the results of annual certification.
(g) Units Cleared Prior to Date of Anreement, Confirmation of Clearance.
In the event the requirements of the LBP REGS relating to lead hazard evaluation, lead hazard
reduction, and lead hazard clearance have been completed on the subject dwelling units prior to
the Date of Agreement, then the SUBRECIPIENT shall provide to the CITY with the April 15
quarterly report a certificate from a qualified inspector evidencing a recent inspection and
confirmation of clearance of LBP and LBP hazards from the subject dwelling unit(s).
5. LBP Informational Summary. For purposes of information only and in no
respect intended to be a representation or warranty of the provisions of the LBP REGS, the CITY
has caused to be prepared an information summary relating to the LBP REGS and application to
dwelling units that may be occupied by recipients of services and/or funding from
SUBRECIPIENT under this Agreement. Attachment No. 4 to this Agreement, attached and
hereby fully incorporated by this reference, is such information summary. CITY staff will
cooperate with and make themselves available to SUBRECIPIENT to assist in implementation of
compliance with the LBP REGS as to residential dwelling units to be assisted by
SUBRECIPIENT. The parties acknowledge and agree the CITY is and shall not be liable or
responsible for the accuracy of such summary, and the SUBRECIPENT is directed to the LBP
REGS and implementing guidance published and provided by HUD relating to compliance with
such LBP REGS.
B. Amount of Grant and Quarterly Disbursement. The amount granted to
SUBRECIPIENT is $90,000 ("CDBG FUNDS"), and such funds shall be expended by
SUBRECIPIENT on or before June 30, 2010. The CDBG FUNDS shall be disbursed by CITY
to SUBRECIPIENT on a quarterly basis, subject to and upon receipt and approval of a complete
quarterly activity report from SUBRECIPIENT, with the final payment subject to the satisfaction
of the condition precedent of submittal of complete reporting information due on or before July
15th of the applicable funding year, as hereinafter more fully set forth. SUBRECIPIENT shall be
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obligated to perform such duties as would normally extend beyond the term, including but not
limited to obligations with respect to indemnification, audits, reporting, data retention/reporting,
and accounting.
C. Use of Funds. SUBRECIPIENT agrees to use all federal funds provided by CITY to
SUBRECIPIENT pursuant to this Agreement to operate said program, as set forth in "Exhibit B",
attached hereto and by this reference incorporated herein. SUBRECIPIENT'S failure to perform as
required may, in addition to other remedies set forth in this Agreement, result in readjustment of the
amount of funds CITY is otherwise obligated to pay to SUBRECIPIENT under Paragraph II hereof.
D. Allowable Costs. SUBRECIPIENT agrees to complete said program on or before
June 30, 2010 and to use said funds to pay for necessary and reasonable costs allowable under the
federal law and regulations to operate said program. Said amounts shall include, but not be limited
to, wages, administrative costs, and employee benefits comparable to other similarly situated
employees. Other allowable program costs are detailed in the Budget, as set forth in "Exhibit B",
attached hereto and by this reference incorporated herein. SUBRECIPIENT shall use all income
received from said funds only for the same purposes for which said funds may be expended
pursuant to the terms and conditions of this Agreement.
E. Licensing. SUBRECIPIENT agrees to obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing its operations.
SUBRECIPIENT shall ensure that its staff shall also obtain and maintain all required licenses,
registrations, accreditation and inspections from all agencies governing SUBRECIPIENT's
operations hereunder. Such licensing requirements include obtaining a City business license, as
applicable.
F. Zoning. SUBRECIPIENT agrees that any facility/property used in furtherance of
said program shall be specifically zoned and permitted for such use(s) and activity(ies). Should
SUBRECIPIENT fail to have the required land entitlement and/or permits, thus violating any local,
state or federal rules and regulations relating thereto, SUBRECIPIENT shall immediately make
good -faith efforts to gain compliance with local, state or federal rules and regulations following
written notification of said violation(s) from the CITY or other authorized citing agency.
SUBRECIPIENT shall notify CITY immediately of any pending violations. Failure to notify CITY
of pending violations, or to remedy such known violation(s) shall result in termination of grant
funding hereunder. SUBRECIPIENT must make all corrections required to bring the
facility/property into compliance with the law within sixty (60) days of notification of the
violation(s); failure to gain compliance within such time shall result in termination of grant funding
hereunder.
G. Separation of Accounts. All funds received by SUBRECIPIENT from CITY
pursuant to this Agreement shall be maintained in an account in a federally insured banking or
savings and loan institution with record keeping of such accounts maintained pursuant to applicable
OMB Circular A-110 requirements. SUBRECIPIENT is not required to maintain separate
depository accounts for CDBG FUNDS; provided however, the SUBRECIPIENT must be able to
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account for receipt, obligation and expenditure of CDBG FUNDS pursuant to applicable OMB
Circular A-110 requirements.
H. Audit Report Requirements. SUBRECIPIENT agrees that if SUBRECIPIENT
receives Five Hundred Thousand Dollars ($500,000.00) or more in federal funds, SUBRECIPIENT
shall have an annual audit conducted by a certified public accountant in accordance with the
standards as set forth and published by the United States Office of Management and Budget.
SUBRECIPIENT shall provide CITY with a copy of said audit by October 1 of the year following
the program year in which this Agreement is executed. Further, SUBRECIPIENT shall comply
and/or cause compliance with audit report(s) required by applicable provisions of Title X and the
LBP Regs.
I. Record Kegping/Renorting. SUBRECIPIENT shall keep and maintain complete and
adequate records and reports to assist CITY in meeting and maintaining its record keeping
responsibilities under the CDBG REGS, Title X, and the LBP Regs, including the following:
(1) Records
a. Documentation evidencing program income requirements in
conformity with 24 CFR 570.504(b((2)(i), (ii) and 24 CFR 570.503(b)(3) and 24
CFR 570.208(a)(2)(B) of the income level of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
b. Documentation of the number of persons and/or families participating
in or benefiting by the SUBRECIPIENT program.
c. Household information shall include number of persons, identification
of head of household, race/ethnicity, and income verification.
d. Documentation of all CDBG FUNDS received from CITY.
e. Documentation of expenses as identified in the Budget Proposal,
including evidence of incurring the expense, invoices for goods or services, copies
of any and all contracts or documentation pertaining to costs for subcontractors,
plus all other invoices for which CDBG FUNDS were expended, and any payments
therefor.
f. Any such other related records as CITY shall reasonably require or as
required to be maintained pursuant to the CDBG REGS.
g. Documentation evidencing compliance with all applicable provisions
of Title X and the LBP Regs, in particular Subpart K and, as applicable Subpart J
and/or Subpart M.
(i) Specific documentation, as required, evidencing
compliance with all applicable provisions of such LBP Regs
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including: (i) notification, including distribution of the lead
hazard information pamphlet (Attachment No. 1), disclosure
and notices of hazard evaluation and reduction (Attachments
No. 2 and 3); (ii) evaluation of lead hazard(s), including paint
testing and risk assessment; (iii) reduction of lead hazard(s),
including safe work practices and clearance, and
confirmation of clearance; and (iv) ongoing maintenance, as
and if applicable for multifamily properties.
(ii) In this regard SUBRECIPIENT shall track information on
all persons/households assisted and the housing units assisted
with the CDBG FUNDS. Attachment No. 5 hereto is a sample
form for tracking persons/households and housing units
assisted with the CDBG FUNDS. All categories of
information set forth in such tracking form shall be prepared
and submitted to the CITY with the April 15 quarterly report.
(iii) In the event that such information and reports are not
complete and reasonably satisfactory information submitted in
order for CITY staff to review and evaluate compliance with
applicable CDBG REGS and LBP Regs, then the final quarterly
disbursement payment shall be withheld from the
SUBRECIPIENT.
(iv) Documentation of clearance confirmation as provided in
Section L(1)(g) hereinabove.
(2) Reports
(i) Payment Request. Concurrently with the submittal of each
quarterly report, on or before the 15th day of October, January,
April and July, SUBRECIPIENT shall submit both: an original
invoice and true copies of invoices, receipts, agreements or
other documentation supporting and evidencing how the CDBG
FUNDS have been expended during the applicable quarter.
(ii) Quarterly Activity Report: Including in such reports
evidence of compliance with all applicable provisions of Title X
and the LBP Regs, in particular Subpart K and, as applicable
Subpart J, as further described in subsection (d) hereinafter, and
Subpart M, if SUBRECIPIENT provides long term tenant -based
rental assistance. SUBRECIPIENT agrees to provide CITY with
written cumulative (year-to-date) reports of its activities on or
before the 15th day of October, January, April and July for the
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period beginning July 1, 2003 and through and including the
previous three-month reporting period setting forth the activities,
program accomplishments, new program information and year-to-
date program statistics on expenditures, caseload and activities.
When appropriate, pictures should be included.
(iii) Any such other reports as CITY (or HUD) shall
reasonably require and/or request, including but not limited to
the following information: the receipt of program income [as
defined at 24 CFR 570.500(a)] by SUBRECIPIENT in the
operation of said program shall be recorded by SUBRECIPIENT
and reported to CITY; monthly records of all ethnic and racial
statistics of persons and families benefited by SUBRECIPIENT in
the performance of its obligations under this Agreement,
including, but not limited to, the number of low and moderate
income persons and households assisted in accordance with
federal income limits and the number of female heads of
households.
(3) Recordkeening of Ongoing Maintenance under the LBP Rees. If the services and
program activities provided by SUBRECIPIENT hereunder establish an ongoing relationship
with a property (such as long term tenant based rental assistance program [Subpart M] or
transitional or permanent housing operated or administered by the SUBRECIPIENT), then the
SUBRECIPIENT shall provide a report to the CITY evidencing that SUBRECIPIENT and/or the
property owner(s), as applicable, has performed ongoing maintenance of the subject property.
Ongoing maintenance shall include evidence of an annual clearance certification of the subject
residential property conducted by a DHS certified technician to ensure that LBP hazard reduction
measures are maintained. All maintenance activities shall be conducted to ensure the threat of
LBP hazards is minimized.
(4) Recordkeeping under the LBP Regs. The SUBRECIPIENT shall keep records of
distribution of notifications, all visual assessment, evaluations, inspections, repairs, and any other
lead hazard evaluation, reduction, safe work practices, and clearance activities.
(a) The SUBRECIPIENT shall keep records evidencing distribution of all lead
hazard information pamphlet(s).
(b) The SUBRECIPIENT shall keep records evidencing each LBP evaluation
report, LBP hazard reduction documentations, (such as job specifications), and all clearance or
abatement report(s).
(c) The SUBRECIPIENT shall keep ongoing maintenance records and records of
relevant building operations for use during reevaluations of subject property for LBP and/or LBP
hazards.
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1. Such records shall be maintained for not less than longer of
(A) three (3) years after the activities cease or (B) the period
required by applicable program regulations. Under the CDBG
REGS records shall be retained for not less than four (4) years after
the activities cease.
2. The SUBRECIPIENT shall provide a copy of any of the
above records to the CITY or to HUD upon request of either or
both.
(d) Tracking Report. If the SUBRECIPIENT has provided, or is providing, rental
assistance payments directed to a housing unit or housing units for more than 100 days, or it is
anticipated that during the last quarter of funding that such rental assistance payment will be for
more than 100 days, then the April 15 quarterly report shall contain information and evidence of
compliance with the requirements herein relating to tracking of housing units, cumulative days of
rental assistance, proper notifications to occupants and owners, HQS inspection, visual
assessment, work write-up, stabilization and clearance of LBP and LBP hazards, if any. The
proposed form of such tracking information is attached hereto as Attachment No. 5 and fully
incorporated by this reference. In the event such April 15 quarterly report does not fully satisfy
the reporting requirements set forth herein and in the LBP Regs, then the final installment
payment of the CDBG FUNDS shall be withheld from disbursement to SUBRECIPIENT.
J. Access to Records. CITY and the United State Government and/or their representatives
shall have access for purposes of monitoring, auditing, and examining SUBRECIPIENT's activities
and performance, to books, documents and papers, and the right to examine records of
SUBRECIPIENT's subcontractors, bookkeepers and accountants, employees and participants in
regard to said program. CITY and the United States Government and/or their representatives shall
also schedule on -site monitoring at their discretion. Monitoring activities may also include, but are
not limited to, questioning employees and participants in said program and entering any premises or
any site in which any of the services or activities funded hereunder are conducted or in which any of
the records of SUBRECIPIENT are kept. Nothing herein shall be construed to require access to any
privileged or confidential information as set forth in federal or state law.
K. Location of Records/Required Length of Record Keening. All accounting records,
reports, and evidence pertaining to all costs, expenses and the CDBG FUNDS of
SUBRECIPIENT and all documents related to this Agreement shall be maintained and kept
available at SUBRECIPIENT'S office or place of business for the duration of the Agreement and
thereafter for five (5) years after completion of an audit in conformity with the CDBG REGS,
except as hereinafter provided relating to retention of any records or documentation existing,
created, or maintained in compliance with Title X or the LBP Regs. Records which relate to (a)
complaints, claims, administrative proceedings or litigation arising out of the performance of this
Agreement, or (b) costs and expenses of this Agreement to which CITY or any other
governmental agency takes exception, shall be retained beyond the five (5) years until complete
resolution or disposition of such appeals, litigation claims, or exceptions. All records relating to,
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or created or maintained in compliance with, Title X and/or the LBP Regs shall be retained and
maintained by SUBRECIPIENT indefinitely, including without limitation, all inspection
report(s), disclosure statement(s), and clearance report(s). In the event SUBRECIPIENT does not
make the above -referenced documents available within the city of Santa Ana, California,
SUBRECIPIENT agrees to pay all necessary and reasonable expenses incurred by CITY in
conducting any audit at the location where said records and books of account are maintained.
L. Compliance with Law/Program Income. SUBRECIPIENT acknowledges that the funds
being provided by CITY for said program are received by CITY pursuant to the ACT as amended
and that expenditures of these funds shall be in accordance with the ACT and all pertinent
regulations issued by agencies of the federal government, including, but not limited to, all
regulations found at Title 24 of the Code of Federal Regulations. Program income received by
SUBRECIPIENT shall be returned to CITY unless otherwise provided for in this Agreement.
SUBRECIPIENT agrees to comply fully with all federal, state and local laws and court orders
applicable to its operation whether or not referred to in this Agreement.
M. Standine. SUBRECIPIENT shall be in good standing, without suspension by the
California Secretary of State, Franchise Tax Board and Internal Revenue Service. Any change in
the corporate status or suspension of SUBRECIPIENT shall be reported immediately to CITY.
N. Confidentiality. Without prejudice to any other provisions of this Agreement,
SUBRECIPIENT shall, where applicable, maintain the confidential nature of information provided
to it concerning participants in accordance with the requirements of federal and state law. However,
SUBRECIPIENT shall submit to CITY and or HUD or its representatives, all records requested,
including audit, examinations, monitoring and verifications of reports submitted by
SUBRECIPIENT, costs incurred and services rendered hereunder.
O. Independent Contractor. SUBRECIPIENT agrees that the performance of
obligations hereunder are rendered in its capacity as an independent contractor and that it is in no
way an agency of CITY.
P. Violation of Terms and Conditions. SUBRECIPIENT agrees that if
SUBRECIPIENT violates any of the terms and conditions of this Agreement or any prior
Agreement whereby CDBG funds were received by SUBRECIPIENT, or if SUBRECIPIENT
reports inaccurately, or if on audit there is a disallowance of certain expenditures, SUBRECIPIENT
agrees to remedy the acts or omissions causing the disallowance and repay CITY all amounts spent
in violation thereof. If SUBRECIPIENT engaged in fraudulent activity to obtain and/or justify
expenditure of the CDBG funds granted hereunder, SUBRECIPIENT shall be required to reimburse
the CITY of all such funds that were obtained/spent under fraudulent circumstances.
Q. Equipment. SUBRECIPIENT agrees to maintain a record for each item of non -
expendable personal property acquired under the terms of this Agreement. Said record shall be
made available to CITY upon request. The term "non -expendable personal property" shall include
leased and purchased equipment.
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R. Prohibited Use. SUBRECIPIENT hereby certifies and agrees that it will not use
funds provided through this Agreement to pay for entertainment, meals or gifts.
S. Lobbying. SUBRECIPIENT certifies that it will comply with federal law (31
U.S.C. 1352) and regulations found at 24 CFR Part 87, which provide that no appropriated funds
may be expended by the recipient of a federal contract, grant, loan or cooperative agreement to pay
any person for influencing or attempting to influence an officer or employee of any agency,
Member of Congress, or an officer or employee of a Member of Congress in connection with
awarding of any federal contract, the making of any federal grant or loan, entering into any
cooperative agreement and the extension, renewal, amendment or modification of any federal
contract, grant, loan or cooperative agreement. SUBRECIPIENT shall sign a certification to that
effect in a form as set forth in "Exhibit C," attached hereto and by this reference incorporated herein.
SUBRECIPIENT shall submit said signed certification to CITY prior to performing any of its
obligations under this Agreement and prior to any obligation arising on the part of CITY to pay any
sums to SUBRECIPIENT under the terms and conditions of this Agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit a "Disclosure Form to Report Lobbying," in accordance
with its instructions (see C-1).
T. Financial Interest. SUBRECIPIENT agrees that except for the use of CDBG funds
to pay salaries and other related administrative or personnel costs, no persons who exercise or have
exercised any function with respect to CDBG activities assisted under the terms of this Agreement,
or who are in a position to participate in a decision -malting process or gain inside information with
regard to such activities, may obtain a financial interest or benefit from a CDBG-assisted activity of
SUBRECIPIENT, either for themselves or those with whom they have family or business ties,
during their tenure or for one year thereafter. This prohibition applies to any person who is an
employee, agent, consultant, officer, or elected or appointed official of CITY, or of
any designated public agencies, or the SUBRECIPIENT.
U. Davis -Bacon Act. All laborers and mechanics employed by contractors or
subcontractors in the performance of construction work, including alterations and repairs, in excess
of $2,000.00, financed in whole or in part with federal funds shall be paid wages at rates not less
than those prevailing on similar construction in the locality as determined in accordance with the
Davis -Bacon Act, as amended, 40 U.S.C. sections 276a - 276a-5. Any such construction contract
shall include and comply with the required contract provisions and rules set forth in 29 C.F.R. §5.5.
Further, the payroll reports (along with the "Statement of Compliance") and basic records are
required to be maintained and submitted, or made available, pursuant to 29 C.F.R. §5.5(a)(3). No
payment, advance, grant, loan or guarantee of funds shall be approved by the federal agency unless
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there is on file with the agency a certification by the contractor that the contractor and its
subcontractors have complied with the provisions of 29 C.F.R. §5.5.. A breach of the contract
clauses in 29 C.F.R. §5.5 may be grounds for termination of the contract, and for debarment as a
contractor/subcontractor, as provided in 29 C.F.R. §5.12. Labor standards interviews/investigations
shall be made as necessary to assure compliance [29 C.F.R. §5.6(a)(3)].
V. Drug Free Workplace. SUBRECIPIENT certifies that it has established the
following drug -free workplace policy:
1. The unlawful manufacture, distribution, dispensing, possession or use of a controlled
substance is prohibited in the workplace for any employee involved in a federally funded program.
2. As an employee working in conjunction with a federally funded program, the
employees of SUBRECIPIENT will be required to:
a) Abide by the terms above in statement 1.
b) Notify appropriate officials of SUBRECIPIENT and CITY officials of any
criminal drug statute conviction for a violation occurring in the workplace not later than five
days after such conviction.
3. The United State Department of Housing and Urban Development will be notified
within ten days after receiving notice of any such violation.
4. Within 30 days of receiving such notice, appropriate personnel action will be
taken against such employee, up to and including termination.
Each such employee shall be required to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a federal, state or local health, law
enforcement, or other appropriate agency.
II. CITY'S OBLIGATIONS
A. Payment of Funds. Upon execution of this Agreement by SUBRECIPIENT, CITY shall
pay to SUBRECIPIENT from CDBG funds, when, if and to the extent received from HUD, for
CITY's 2009-2010 CDBG program year amounts expended by SUBRECIPIENT in carrying out
said program for fiscal year 2009-2010 pursuant to this Agreement up to a maximum aggregate
payment of Ninety Thousand Dollars Dollars ($90,000 ) in installments determined by CITY.
Payments shall be made to SUBRECIPIENT through the submission of invoices on a quarterly
basis (October, January, April and July) in a form prescribed by CITY, detailing such expenses.
CITY shall pay such invoices within thirty (30) days after receipt thereof provided CITY is satisfied
that such expenses have been incurred and documented within the scope and provisions of this
Agreement and that SUBRECIPIENT is in compliance with the terms and conditions of this
Agreement, and in compliance with Title X and the LBP Regs.
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B. Audit of Account. CITY shall include an audit of the account maintained by
SUBRECIPIENT in CITY's annual audit of all CDBG FUNDS in accordance with Title 24 of
the Code of Federal Regulations and other applicable federal laws and regulations.
C. Common Rule: Pursuant to CFR 85.40(a), the CITY manages the day-to-day
operations of each grant and subgrant supported activities. CITY staff has detailed knowledge of
the grant program requirements and monitors grants and subgrant supported activities to assure
compliance with Federal requirements. Such monitoring covers each program, function and
activity and performance goals are reviewed periodically.
D. Environmental Review: hi accordance with 24 SFR 58, the CITY is responsible
for undertaking environmental review and maintaining environmental review records for each
applicable project.
E. Performance Monitoring: CITY shall monitor the performance of the
SUBRECIPIENT against goals and performance standards required herein. Substandard
performance as determined by the CITY will constitute non-compliance with this Agreement. If
action to correct such substandard performance is not taken by the SUBRECIPIENT within a
reasonable period of time after being notified by the CITY, contract suspension or termination
procedures will be initiated.
SUBRECIPIENT agrees that no person on the ground of race, age, color, national origin,
religion or sex will be excluded from participation in, be denied the benefits of, or be subjected to
discrimination under any program or activity funded in whole or in part with CDBG funds.
IV. CONFLICT OF INTEREST
Pursuant to the conflict of interest requirements set forth in 24 CFR 576.5 and OMB
Circulars 1-102 and A-1107, SUBRECIPIENT agrees that no officer, employee, agent or assignee
of CITY having direct or indirect control of any CDBG monies granted to the CITY, inclusive of
the subject CDBG FUNDS, shall serve as an officer of SUBRECIPIENT. Further, any conflict or
potential conflict of interest of any officer of SUBRECIPIENT shall be fully disclosed in writing
prior to the execution of this Agreement and said writing shall be attached and deemed fully
incorporated as a part hereof. Notice shall be sent by SUBRECIPIENT to CITY regarding any
changes or modifications to its board of directors and list of officers.
V. SPECIAL CERTIFICATION FOR RELIGIOUS ENTITIES
If SUBRECIPIENT is a religious entity, SUBRECIPIENT hereby agrees that in connection
with the provision of the services SUBRECIPIENT shall provide with CDBG funds in accordance
with 24 CFR 570.2000):
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A . SUBRECIPIENT shall not discriminate against any employee or applicant for
employment on the basis of religion and shall not limit employment or give preference in
employment to persons on the basis of religion.
B. SUBRECIPIENT shall not discriminate against any person applying for the services
SUBRECIPIENT agrees to provide under the terms of this Agreement on the basis of religion and
shall not limit such services or give preference to applicants for such services on the basis of
religion.
C. SUBRECIPIENT shall NOT provide religious instruction or counseling, conduct
any religious worship or services, or engage in any religious proselytizing, or exert any religious
influence in the provision of the services in said program. The parties agree that this covenant is
intended to and shall be construed for the limited purpose of assuring compliance with respect to the
use of CITY funds by SUBRECIPIENT with applicable constitutional limitations respecting the
establishment of religion as set forth in the establishment clause under the First Amendment of the
United States Constitution and Article I, Section 4 of the California Constitution, and is not in any
manner intended to restrict other activities of SUBRECIPIENT.
D. Where the services to be provided under said program are rendered on property
owned by the primarily religious entity SUBRECIPIENT, CDBG funds may also be used for minor
repairs to such property which are directly related to the cost of rendering the services under said
program, where the cost constitutes in dollar terms only an incidental portion of the CDBG
expenditure for rendering the services under said program.
VI. PROHIBITION OF NEPOTISM
SUBRECIPIENT agrees not to hire or permit the hiring of any person to fill a position
funded through this Agreement if a member of that person's immediate family is employed in an
administrative capacity by SUBRECIPIENT. For the purposes of this section, the term "immediate
family" means spouse, child, mother, father, brother, sister, brother-in-law, sister-in-law, father-in-
law, mother-in-law, son-in-law, daughter-in-law, aunt, uncle, niece, nephew, stepparent and
stepchild. The term "administrative capacity" means having selection, hiring, supervisor or
management responsibilities.
VII. NOTICES
Notices to the parties shall, unless otherwise requested in writing, be sent by U.S. Mail,
postage prepaid, and addressed as follows:
TO CITY: City of Santa Ana
Community Development Agency (M-25)
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, California 92702-1988
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TO SUBRECIPIENT: Debbie Schultz
Paint Your Heart Out, Inc
1260 N. Hancock St. Ste. 103
Anaheim, CA 92807
VIII. ASSIGNABILITY
None of the duties of, or work to be performed by, SUBRECIPIENT under this Agreement
shall be subcontracted or assigned to any agency, consultant, or person without the prior written
consent of CITY. SUBRECIPIENT must submit all subcontracts and other agreements that relate
to this Agreement to CITY. No subcontract or assignment shall terminate or alter the legal
obligations of SUBRECIPIENT pursuant to this Agreement.
IX. HOLD HARMLESS
SUBRECIPIENT shall indemnify and save harmless CITY, its officers, employees, agents,
representatives and volunteers from and against any and all damages to or for loss of use of property
and for injuries to or death of any person or persons, including property and employees or agents of
CITY, and shall defend, indemnify and save harmless CITY, its officers, employees, agents,
representatives and volunteers from and against any and all claims, demands, suits, actions or
proceedings of any kind or nature, including, but not by way of limitation, workers compensation
claims and including attorney fees and reasonable expenses for litigation or settlement, resulting
from or arising out of the negligent or wrongful acts, errors or omissions of SUBRECIPIENT, its
officers, directors, employees, agents, subcontractors and suppliers arising out of
SUBRECIPIENT's performance of this Agreement.
X. INSURANCE
A. In accordance with the provisions of Section 3300 of the Labor Code, if
SUBRECIPIENT has any employees it is required to be insured against liability for worker's
compensation or to undertake self-insurance. Prior to commencing performance of this
Agreement, SUBRECIPIENT agrees to obtain and maintain employer's liability insurance with
limits not less than $1,000,000 per accident. If SUBRECIPIENT has no employees, nor workers'
compensation coverage, it must execute a Declaration available from the CITY, and update as is
necessary.
B. SUBRECIPIENT shall undertake self-insurance, or shall obtain, at its sole cost, a
policy or policies of commercial general liability insurance, or equivalent form, with a combined
single limit of not less than $1,000,000 per occurrence.
Such insurance shall: (1) name the City of Santa Ana, its officers, agents,
representatives, employees and volunteers as additional insureds; (2) be primary with respect to
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insurance or self-insurance programs maintained by the CITY; (3) contain standard separation of
insureds provisions; and (4) give to CITY prompt and timely notice of claim made or suit
instituted arising out of SUBRECIPIENT's operations hereunder.
SUBRECIPIENT shall: (a) prior to exercising any right under this Agreement,
fumish properly executed certificates of insurance and additional insured endorsement to the
CITY which shall clearly evidence all coverages required above; (b) provide that such insurance
shall not be materially changed or terminated except on 30 days prior written notice to the CITY;
(c) maintain such insurance for the period covered by this Agreement; and (d) replace such
certificates for policies expiring prior to the expiration of this Agreement.
XI. REVERSION OF ASSETS
A. Upon the expiration of this Agreement, SUBRECIPIENT shall transfer to CITY any
CDBG funds on hand at the time of the expiration of this Agreement as well as any accounts
receivable attributable to the use of CDBG funds. [24 CFR 570.503(b)(8).]
B. Any real property under SUBRECIPIENT's control that was acquired or improved
in whole or in part with CDBG funds in excess of $25,000.00 must either be:
1. Used, where CITY has given written approval, to meet one of the national
objectives stated in 24 CFR 570.208 until five (5) years after expiration of this Agreement, or for
such longer period of time as determined to be appropriate by CITY; or
2. If not used in accordance with subparagraph A above, SUBRECIPIENT
shall pay to CITY an amount equal to the current fair market value of the property less any portion
of the value attributable to the expenditure of non-CDBG funds for acquisition of, or improvement
to, the property. Such payment is program income to CITY.
C. Subject to the obligations set forth herein, title to equipment acquired under the
terms of this Agreement will vest upon acquisition in SUBRECIPIENT. When said equipment
which has been acquired in accordance with this Agreement and all applicable regulations is no
longer needed for said program, disposition of said equipment will be made as follows:
1. Items of equipment with a current per unit fair market value of less than
$5,000.00 may be retained, sold or otherwise disposed of with no further obligation to CITY.
2. Items of equipment with a current fair market per unit value of $5,000.00 or
more may be retained or sold and CITY shall have the right to an amount calculated by multiplying
the current market value or proceeds from the sale by CITY's share of federal funds used to acquire
the equipment, in accordance with 24 CFR 85.32(e)(2).
D. SUBRECIPIENT hereby agrees, upon the demand of CITY, to execute,
acknowledge and deliver, or cause any person or entity who may have any claim to rights hereunder
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or under any document, instrument or agreement executed in furtherance of the services and
activities to be performed hereunder, to execute, acknowledge and deliver, to CITY assignment(s),
quit claim deed(s) or such other and further instruments, documents and agreements as may be
necessary, in the sole and absolute discretion of CITY, to vest in CITY all of SUBRECIPIENT's
right, title and interest (if any it may have) in and to CITY, CDBG or other federal, state and/or
local accounts or program funds or allocation of funds to which CITY is or may be entitled, either
for its own account or as fiduciary or trustee for others, which were obtained for the purpose of the
performance of this Agreement or any previous agreements relating to the same subject matter or
activities as this Agreement, together with any instruments, loans, grants or advances by
SUBRECIPIENT on behalf of CITY, in furtherance of the activities hereunder or thereof.
SUBRECIPIENT's obligations and responsibilities set forth in this paragraph "XI.
REVERSION OF ASSETS," and in paragraph "XII. TERMINATION" and other requirements
pertaining to program income shall not be affected by the termination of this Agreement and shall
survive the date of termination of this Agreement for such period of time as CITY and/or HUD
deems necessary for the responsibilities, duties and obligations to be performed and completed to
the satisfaction of CITY and HUD.
XII. TERMINATION
A. This Agreement may be terminated on thirty (30) days' written notice by either
party. In the event of such termination, SUBRECIPIENT shall only be entitled to reimbursement
for approved expenses incurred to the effective date of termination.
B. This Agreement may be suspended or terminated by CITY upon five (5) days'
written notice for violation by SUBRECIPIENT of Federal Laws governing the use of Community
Development Block Grant Funds. In the event of such suspension or termination, SUBRECIPIENT
shall only be entitled to reimbursement for approved expenses incurred up to the effective date of
suspension or termination.
C. Pursuant to 24 CFR 85.43, in the event SUBRECIPIENT defaults by failing to fulfill
all or any of its obligations hereunder, CITY may declare a default and termination of this
Agreement by written notice to SUBRECIPIENT, which default and termination shall be effective
on a date stated in the notice which is to be not less than ten (10) days after certified mailing or
personal service of such notice, unless such default is cured before the effective date of termination
stated in such notice. If terminated for cause, CITY shall be relieved of further liability or
responsibility under this Agreement, or as a result of the termination thereof, including the payment
of money, except for payment for approved expenses incurred for services satisfactorily and timely
performed prior to the mailing or service of the notice of termination, and except for reimbursement
of (1) any payments made for services not subsequently performed in a timely and satisfactory
manner, and (2) costs incurred by CITY in obtaining substitute performance.
D. The grant of funds under this Agreement may be terminated for convenience in
accordance with 24 CFR 85.44.
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E. The grant of funds under this Agreement may be terminated due to the non-
performance of SUBRECIPIENT and/or failure of SUBRECIPENT to perform the work described
in Exhibits A and B or failure to meet the performance standards and program goals set forth
therein.
F. In the event this Agreement is terminated as set forth in subparagraphs XII.A.
through XII.E., inclusive, SUBRECIPIENT agrees to immediately return to CITY upon CITY's
demand and prior to any adjudication of SUBRECIPIENT's rights, any and all funds not used, and
to comply with paragraph "XI. REVERSION OF ASSETS" of this Agreement.
XIII. LIMITATION OF FUNDS
The United States of America, through HUD, may in the future place programmatic or fiscal
limitations on the use of CDBG funds which limitations are not presently anticipated. Accordingly,
CITY reserves the right to revise this Agreement in order to take account of actions affecting HUD
program funding. In the event of funding reduction, CITY may, in its sole and absolute discretion,
reduce the budget of this Agreement as a whole or as to costs category, may limit the rate of
SUBRECIPIENT's authority to commit and spend funds, or may restrict SUBRECIPIENT's use of
both its uncommitted and its unspent funds. Where HUD has directed or requested CITY to
implement a reduction in funding, in whole or as to a cost category, with respect to funding for this
Agreement, CITY's City Manager or delegate is authorized to act for CITY in implementing and
effecting such a reduction and in revising, modifying, or amending the Agreement for such
purposes. If such a reduction in funding occurs, SUBRECIPIENT shall be permitted to de -scope
accordingly. Where CITY has reasonable grounds to question SUBRECIPIENT's fiscal
accountability, financial soundness, or compliance with this Agreement, CITY may suspend the
operation of this Agreement for up to sixty (60) days upon five (5) days written notice to
SUBRECIPIENT of its intention to so act, pending an audit or other resolution of such questions.
In no event, however, shall any revisions made by CITY affect expenditures and legally binding
commitments made by SUBRECIPIENT before it received notice of such revision, provided that
such amounts have been committed in good faith and are otherwise allowable and that such
commitments are consistent with HUD cash withdrawal guidelines.
XIV. EXCLUSIVITY AND AMENDMENT OF AGREEMENT
This Agreement supersedes any and all other agreements, either oral or in writing, between
the parties hereto with respect to the use of CITY's CDBG funds by SUBRECIPIENT and contains
all the covenants and agreements between the parties with respect to such employment in any
manner whatsoever. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone
acting on behalf of any parry, which are not embodied herein, and that no other agreement or
amendment hereto shall be effective unless executed in writing and signed by both CITY and
SUBRECIPIENT.
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XV. LAWS GOVERNING THIS AGREEMENT
This Agreement shall be governed by and construed in accordance with the laws of the State
of California, and all applicable federal laws and regulations.
XVI. VALIDITY
The invalidity in whole or in part of any provision of this Agreement shall not void or affect
the validity of any other provision of this Agreement.
XVII. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and wan -ants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify CITY fully, including reasonable costs and attorney's fees, for any injuries or damages to
CITY in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits and Attachments referenced herein and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
c. No delay or omission by either party hereto to exercise any right or power accruing
upon any noncompliance or default by the other party with respect to any of the terms of this
Agreement shall impair any such right or power or be construed to be a waiver thereof. A
waiver by either of the parties hereto of any of the covenants, conditions, or agreements to be
performed by the other shall not be construed to be a waiver of any succeeding breach thereof
or of any other covenant, condition or agreement herein contained.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the last date and
year written below.
ATTEST:
PATRICIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By: LISA E. STORCK
Assistant City Attorney
CITY OF SANTA ANA
V• City Manager
SUBRECIPIENT:
DATEif-��: ()1tc��
Name: -h-et L i 't- Se !) �-(' H C-
Title:�-L_e-1�� I-c-c_foi
Tax ID:33-6915612
23
City of Santa Ana
Scope of Work
Name of Organization Paint Your Heart Out, Inc.
Name of Funded Program Paint Day Santa Ana
Annual Accomplishment Goal
I. Total number of unduplicated Households (Santa Ana and Non -Santa Ana Households) anticipated to be served by
the funded program, named above, during the 12-month contract period.
15 Households
II. Number of ONLY unduplicated Santa Ana Households to be served by the funded program, named above, during
the 12-month contract period.
15 Households
Program and Funding Description
III. Description of Work - In the space below, describe the program to be funded during the 12-month contract period.
What specific activities will be undertaken during the contract period. Please be concise in your response. Only the
viewable space will print.
purpose of Paint Day Santa Ana is to restore hope to low-income seniors and disabled homeowners by completing
airs, restoring and painting their homes, at no cost to homeowners. The program counters neighborhood blight and
motes community pride through volunteerism. PYHO's 500-member Paint Day Santa Ana volunteer army completes the
ne refurbishing work. Hundreds of volunteers will be recruited from the community to repair and refurbish 15 homes in
City of Santa Ana for low-income to moderate -income senior and/or disabled homeowners. The restoration of hope and
italization of community takes place annually on Paint Day Santa Ana. Each home receives an average of $7,000 in
erior and landscape improvements. Specific services provided during the year to execute Paint Day Santa Ana include: 1)
Bening applicants on the waiting list, 2) outreach to the target neighborhoods for additional applicants, 3) meeting with
imunity leadership to accomplish project goals, 4) training project volunteers, 5) securing resources to perform repairs,
p work and painting, 6) assessing all selected homes and creating work plans for each, 7) completing the prep and
sting of 15 homes, an 8) recognizing volunteers and sponsors.
ita Ana residents will receive home restoration services for Paint Day that may include:
epairs around the house
3ndscaping/tree trimming
tucco repair and wood replacement
iandrails if needed
prepping and exterior painting
other needed repairs as discovered
2) replacing broken windows & locks
5) garage door replacement/repairs
7) referral to CAPOC
9) lead paint abatement
11) waste removal
repairs will average $7,000 per house and will denote approximately $105,000 in Santa Ana community
Estimate the number of ONLY unduplicated Santa Ana households to be served by the funded program during the 12-
month contract period per quarter. (Enter number of new Santa Ana households served each quarter. If they were
served in quarter 1 do not count them again inquarter 2
Quarter 1: July 1 - September 30 & Households
Quarter 2: October 1 - December 31 6 Households
Quarter 3: January 1 - March 31 3 Households
Quarter 4: April 1 -June 30 Households
15 Total unduplicated Santa Ana Residents to be served.
Schedule of Invoicing
Estimate the amount of grant funds to be requested during the 12-month contract period on a quarterly basis.
Quarter 1: July 1 - September 30 1 $; 22,500.00`
Quarter 2: October 1 - December 31 r $ 22 500i00
Quarter 3: January 1 - March 31 $ -22 500.00-
Quarter 4: April 1 -June 30 $" 22,5020.00
$ 90,000.00 (Total Grant
Exhibit A
Page 1 of 1
City of Santa Ana
Performance Outcome Tracking
Please find the activity most closety associated to the service that will be provided and place an "X" next to it then answer
the question below. Please note the trackin that is involv d 'th h'
Place an
e wl t Is
aCLIVIty.
'X' next to
one
Activity/
Activity
-
Program
Fair Housing
Services
City Outcome Tracking
Provide fair housing service
and ongoing analysis of
impediments to fair
housing.
Goal
1. Provide fair housing
counseling, education and
enforcement services to
7,000 Santa Ana
households.
"'5-year goal to be
achieved by FY 09110
HUD Outcome Tracking
Number of persons assisted:
with new access to a service
-with improved access to a service
-where activity was used to meet a
quality standard or measurably improved
quality, report the number that no longer
only have access to substandard service
HUD Goal
Accessibility for the
purpose of providing
Decent Affordable
Housing
2. Annually assess actionse
to eliminate impediments
to fair housing.
Number of persons assisted:
-with new access to a service
-with improved access to a service
Accessibility for th
purpose of providing
Decent Affordable
-where activity was used to meet a
Housing
quality standard or measurably improved
quality, report the number that no longer
only have access to substandard service
X
Owner-
Occupied
Housing
Rehabilitation
Number of owners assisted
to rehabilitate their primary
residence for the following
income categories:
-Extremely Low Income
Very Low Income
-Moderate Income
Special Needs Categories
-Large Families
Physical safety and
comfort will be improved
for Low and Moderate
income households by
improving homes to a level
that meets or exceeds
HUD housing quality
standards.
Total number of units:
-Number occupied by elderly
-Number of units brought from
substandard to standard condition (HOS
or local code)
-Number qualified as Energy Star
-Number of units brought into compliance
with lead safe housing rule (24 CFR part
35)
Accessibility for the
purpose of providing
Decent Affordable
Housing
-Number of units made accessible for
persons with disabilities
Describe how you will gather the tracking information, noted above, for that activity.
1) Home visits and telephone contact will be used to assess the total number of Santa Ana seniors who avoid
institutional care and continue to live independently in their renovated home as a result of Paint Day Santa Ana
during 12-month period after services are provided.
2) Tablulate the total number of new and unduplicated Santa Ana seniors who received Paint Day Santa Ana
home restoration services in 1009-10.
3) Paint Day client evaluation form.
4) Client home visits and evaluations will be conducted to determine satisfaction of service and measure each
homeowner's assessment of his/her standard of living following Paint Day.
Exhibit A-1
Page 3 of 3
Organization Name
Program Name
Program Year 2009-2010
Final Budget
Expenditures
Category
Administrative Staff
Salaries & Benefits
Program Staff Salaries &
Benefits
Contractual/Professional
Services
Expenses Funded by
Santa Ana CDBG
$ 10,000
$ 25,000
$ 23,000
Expenses Funded
by Other Sources
Total Program
Budget
$ 10,000
$ 25,000
$ 23,000
Total Organizational
Bud et
Office Supplies
$ 1,000
$ 1,000
Rent
$
Communications
$
Utilities
$ 650
$ 650
Insurance
$ 1,400
$ 1,400
Other: List below
$ 2,700
$ 2,700
ILI
1 Community Relations
2 Painting/Prep Supplies
$ 25,750
$ 25,750
3 Dumpsters
$ 500
$ 500
4
$
5
$
Total
$ 90,000
$
$ 90,000
$
LIST ALL OTHER PROGRAM FUNDS THAT HAVE BEEN SECURED FOR 08-09
(Total Funds for Program must equal Total Program Budget above)
Source Amount
Santa Ana CDBG $ 90,000
Total Funds for the Program $ 9o,000
Exhibit B
Page 1 of 1
Name of Organization:
Name of Program
NOTE: Please remember that this
ADMINISTRATIVE. STAFF
2009-2010 Funded Personnel
budget
on
Position Title
Annual
Annual
Total
CDBG Funds
Of this time
Maximum
Salary
Benefits
Compensation
Requested for
percent of
Amount of
this position
time serving
eligible
Santa Ana
Complensation
Executive Director
$ 12,000
$ 6,348
$ 18,348
$ 3 000
$
Administrative Assistant
$ 31,200
$ 4,332
$ 35,532
$ 5,000
$
5ookkeerter
$ 11,232
$
$ 11,232
$ 2,000
$
$$
$
$
$
$
Total Amount R nested
$ 10 000
Must equal amount indicated on Exhbit B
PROGRAM STAFF
Position Title
Annual
Salary
Annual
Benefits
Total
Compensation
CDBG Funds
Requested for
this position
Oft is time
percent of
time serving
Santa Ana
Maximum
Amount of
eligible
Coniglensation
Program Director
$ 25,000
$ 25 000
$ 25 000
$
Total Amount RequestedRequestedl
$ 25,000
Must equal amount indicated on Exhbit B
CONTRACTUAL/PROFESSIONAL SERVICES
Type of Service
Annual Contract Amount
Total
Compensation
CDBG Funds
Requested for
this position
Of this time
percent of
time serving
Santa Ana
Maximum
Amount of
eligible
1 n n
Lead Abatement
$
$ 23 000
$
Total Amount RequestedRequestedl
$ 23.000
Must equal amount indicated on Exhbit B
***Please note for personnel whose time is not directly traced to serving Santa Ana and instead a percentage is used please
confirm the percentage is accurate prior to requesting reimbursement.
Exhibit B-1
Page I of 1
Certification Regarding Lobbying
Certification for Contracts, Grants. Loans and Cooperative Agreements
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or
an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any Federal contact, grant, loan or cooperative
agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in connection with this Federal contract, grant, loan, or cooperative
agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure
Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontract, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed
when this transaction was made or entered into. Submission of this certification is a
prerequisite for making or entering into this transaction imposed by Section 1352, Title
31, U. S. Code. Any person who fails to file the required certification shall be subject to
a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Name of Certifying Officer Signature ate
EXHIBIT C
Page 1 of 2
SUBRECIPIENT warrants the following:
1. SUBRECIPIENT will comply with Public Law 88-352, Title VI of the Civil Rights
Act of 1964 (42 U. S. C. section 2000 et seq.) and implementing regulation in 24 CFR
Part 1.
2. No person in the United States shall on the ground of race, color, religion, national
origin, or sex, be excluded from participation in, or be denied the benefits of, or be
subjected to discrimination under any program or activity funded in whole or in part with
community development funds made available pursuant to the ACT.
3. All laborers and mechanics, employed by contractors or subcontractors in the
performance of construction work financed in whole or in part with community
development funds shall be paid wages at rates not less than those prevailing on similar
construction in the locality as determined in accordance with the Davis -Bacon Act, as
amended, 40 U. S. C. Sections 276 a 1-5, except for individuals who perform services for
which they volunteered; do not receive compensation for such services; or are paid
expenses, reasonable benefits, or a nominal fee for such services; and are not otherwise
employed at any time in construction work.
4. SUBRECIPIENT will comply with all Federal statutes applicable to projects funded
with community development funds, except that (a) SUBRECIPIENT does not assume
CITY'S environmental responsibilities described at 24 CFR 570.604; and (b)
SUBRECIPIENT does not assume CITY'S responsibility for initiating the review process
under Executive Order 12372.
EXHIBIT C
Page 2 of 2
If you think your home has high
levels of lead:
Get your young children tested for lead, even if
they seem healthy.
♦ Wash children's hands, bottles, pacifiers, and toys
often.
♦ Make sure children eat healthy, low -fat foods.
Get your home checked for lead hazards.
♦ Regularly clean Floors, window sills, and other
surfaces.
Wipe soil off shoes before entering house.
♦ Talk to your landlord about fixing surfaces with
peeling or chipping paint.
Take precautions to avoid exposure to lead dust
when remodeling or renovating (call 1-800-424-
LEAD for guidelines).
Don't use a belt -sander, propane torch, high
temperature heat gun, scraper, or sandpaper on
painted surfaces that may contain lead.
♦ Don't try to remove lead -based paint yourself.
iment 1
1 of 16
Protect
Your
Family
From
Lead In
Your
Home
.=.EPA United States
Environmental
Protection Agency
United States
Consumer Product
Safety Commission
United States
III�III) Department of Housing
and Urban Development
Are You Planning To Buy, Rent, or Renovate
a Home Built Before 1978?
Many houses and apartments built before 1978 have
paint that contains high levels of lead (called lead -
based paint). Lead from paint, chips, and dust can
pose serious health hazards if not taken care of properly.
®® OWNERS, BUYERS, and RENTERS are
encouraged to check for lead (see page 6)
before renting, buying or renovating pre-
1978 housing.
ederal law requires that individuals receive certain
information before renting, buying, or renovating
pre-1978 housing:
FOR i' LANDLORDS have to disclose known infor-
mation on lead -based paint and lead -based
paint hazards before leases take effect.
Leases must include a disclosure about
lead -based paint.
FOR SELLERS have to disclose known informa-
$AIM tion on lead -based paint and lead -based
paint hazards before selling a house. Sales
contracts must include a disclosure about
lead -based paint. Buyers have up to 10
days to check for lead.
RENOVATORS disturbing more than 2 square
feet of painted surfaces have to give you
this pamphlet before starting work.
Attachment 1
Page 3 of 16
IMPORTANT!
Lead From Paint, Dust, and
Soil Can Be Dangerous if Not
Managed Properly
FACT. Lead exposure can harm young
children and babies even before they
are born.
FACT. Even children who seem healthy can
have high levels of lead in their bodies.
FACT: People can get lead in their bodies by
breathing or swallowing lead dust, or by
eating soil or paint chips containing
lead.
FACT: People have many options for reducing
lead hazards. In most cases, lead -based
paint that is in good condition is not a
hazard.
FACT: Removing lead -based paint improperly
can increase the danger to your family.
If you think your home might have lead
hazards, read this pamphlet to learn some
simple steps to protect your family.
Attachment 1
Page 4 of 16
Lead Gets in the Body in Many Ways
Childhood
People can get lead in their body if they:
lead
♦ Breathe in lead dust (especially during
poisoning
renovations that disturb painted
surfaces).
remains a
♦ Put their hands or other objects
major
covered with lead dust in their mouths.
environmen-
tal health
♦ Eat paint chips or soil that contains
lead.
problem in
the U.S.
Lead Is even more dangerous to children
under the age of 6:
♦ At this age children's brains and nervous
systems are more sensitive to the dam-
aging effects of lead.
Even children
♦ Children's growing bodies absorb more
who appear
lead.
healthy can
have danger-
♦ Babies and young children often put
ous levels of
their hands and other objects in their
lead in their
mouths. These objects can have lead
bodies.
dust on them.
Lead is also dangerous to women of
childbearing age:
11
Women with a high lead level in their
system prior to pregnancy would expose
Lead's Effects
It is important to know that even exposure
to low levels of lead can severely harm
children.
In children, lead can cause:
♦ Nervous system and kidney damage.
♦ Learning disabilities, attention deficit
disorder, and decreased intelligence.
♦ Speech, language, and behavior
problems.
♦ Poor muscle coordination.
♦ Decreased muscle and bone growth. ,owe,
we,
♦ Hearing damage. `/
While low -lead exposure is most
common, exposure to high levels of
lead can have devastating effects on
children, including seizures, uncon-
sciousness, and, in some cases, death.
Although children are especially
susceptible to lead exposure, lead
can be dangerous for adults too.
Digestive
In adults, lead can cause: Problems
♦ Increased chance of illness during
pregnancy.
♦ Harm to a fetus, including brain
damage or death.
Reproductive
Problems
(Adults)
♦ Fertility problems (in men and women).
♦ High blood pressure.
♦ Digestive problems.
♦ Nerve disorders.
♦ Memory and concentration problems.
♦ Muscle and joint pain.
or Nerve Damage
Hearing
Lead affects
the body in
many ways.
Attachment 1 3
Page 6 of 16
Where Lead -Based Paint Is Found
in general,
the older your
home, the
more likely it
has lead -
based paint.
Many homes bulk before 1978 have lead.
based paint. The federal government
banned lead -based paint from housing in
1978. Some states stopped its use even
earlier. Lead can be found:
♦ In homes in the city, country, or suburbs.
♦ In apartments, single-family homes, and
both private and public housing.
♦ Inside and outside of the house.
♦ In soil around a home. (Soil can pick up
lead from exterior paint or other sources
such as past use of leaded gas in cars.)
Checking Your
Family for Lead
Get your
To reduce your child's exposure to lead,
get your chill checked, have your home
children and
tested (especially if your home has paint
home tested
in poor condition and was built before
if you think
1978), and fix any hazards you may have.
your home
Children's blood lead levels tend to increase
has high IeY-
rapidly from 6 to 12 months of age, and
tend to peak at 18 to 24 months of age.
els of lead.
Consult your doctor for advice on testing
your children. A simple blood test can
detect high levels of lead. Blood tests are
usually recommended for:
♦ Children at ages 1 and 2.
♦ Children or other family members who
have been exposed to high levels of lead.
♦ Children who should be tested under
your state or local health screening plan.
Your doctor can explain what the test results
mean and if more testing will be needed.
Attachment 1
Page 7 of 16
Identifying Lead Hazards
Lead -based paint is usually not a hazard if
it is in good condition, and it is not on an
Lead from
impact or friction surface, like a window. It
paint chips,
is defined by the federal government as
which you
paint with lead levels greater than or equal
to 1.0 milligram per square centimeter, or
can see, and
more than 0.5% by weight.
lead dust,
Deteriorating lead -based paint (peeling,
Which you
chipping, chalking, cracking or damaged)
can't always
is a hazard and needs immediate attention.
see, can both
It may also be a hazard when found on sur-
be serious
faces that children can chew or that get a
hazards.
lot of wear -and -tear, such as:
♦ Windows and window sills.
♦ Doors and door frames.
♦ Stairs, railings, banisters, and porches.
Lead dust can form when lead -based paint is scraped, sanded, or
heated. Dust also forms when painted surfaces bump or rub togeth-
er. Lead chips and dust can get on surfaces and objects that people
touch. Settled lead dust can re-enter the air when people vacuum,
sweep, or walk through it. The following two federal standards have
been set for lead hazards in dust:
♦ 40 micrograms per square foot (ug/11:2) and higher for Floors,
including carpeted floors.
♦ 250 11g/ft2 and higher for interior window sills.
Lead in soil can be a hazard when children play in bare soil or
when people bring soil into the house on their shoes. The following
two federal standards have been set for lead hazards in residential
soil:
♦ 400 parts per million (ppm) and higher in play areas of bare soil.
♦ 1,200 ppm (average) and higher in bare soil in the remainder of
the yard.
The only way to find out if paint, dust and soil lead hazards exist is
to test for them. The next page describes the most common meth-
ods used.
Attachment 1
Page 8 of 16
Checking Your Home for Lead
Just knowing
that a home
has lead -
based paint
may not tell
you if there
is a hazard.
You can get your home tested for lead in
several different ways:
♦ A paint inspection tells you whether your
home has lead -based paint and where it
is located. It won't tell you whether or not
your home currently has lead hazards.
A risk assessment tells you if your home
currently has any lead hazards from lead
in paint, dust, or soil. It also tells you what
actions to take to address any hazards.
A combination risk assessment and
inspection tells you if your home has
any lead hazards and if your home has
any lead -based paint, and where the
lead -based paint is located.
Hire a trained and certified testing profes-
sional who will use a range of reliable
methods when testing your home.
Usual inspection of paint condition
and location.
♦ A portable x-ray fluorescence (XRF)
machine.
♦ Lab tests of paint, dust, and soil
samples.
There are state and federal programs in
place to ensure that testing is done safely,
reliably, and effectively. Contact your state
or local agency (see bottom of page 1 1) for
more information, or call 1-800-424-LEAD
(5323) for a list of contacts in your area.
Home test kits for lead are available, but
may not always be accurate. Consumers
should not rely on these kits before doing
renovations or to assure safety.
Attachment 1
Page 9 of 16
What You Can Do Now To Protect
Your Family
If you suspect that your house has lead
hazards, you can take some immediate
steps to reduce your family's risk:
If you rent, notify your landlord of
peeling or chipping paint.
♦ Clean up paint chips immediately.
Clean floors, window frames, window
sills, and other surfaces weekly. Use a
mop or sponge with warm water and a
general all-purpose cleaner or a cleaner
made specifically for lead. REMEMBER:
NEVER MIX AMMONIA AND BLEACH
PRODUCTS TOGETHER SINCE THEY
CAN FORM A DANGEROUS GAS.
Thoroughly rinse sponges and mop
heads after cleaning dirty or dusty
areas.
♦ Wash children's hands often, especial-
ly before they eat and before nap time
and bed time.
♦ Keep play areas clean. Wash bottles,
pacifiers, toys, and stuffed animals
regularly.
♦ Keep children from chewing window
sills or other painted surfaces.
♦ Clean or remove shoes before
entering your home to avoid
tracking in lead from soil.
♦ Make sure children eat
nutritious, low -fat meals high
In iron and calcium, such as
spinach and dairy products.
Children with good diets absorb
less lead.
Attachment 1
Page 10 of 16
Reducing Lead Hazards In The Home
Removing
lead
improperly
can increase
the hazard to
your family
by spreading
even more
lead dust
around the
house.
Always use a
professional who
is trained to
remove lead
hazards safely.
M
In addition to day-to-day cleaning and good
nutrition:
♦ You can temporarily reduce lead hazards
by taking actions such as repairing dam-
aged painted surfaces and planting grass
to cover soil with high lead levels. These
actions (called "interim controls") are not
permanent solutions and will need ongo-
ing attention.
To permanently remove lead hazards,
you should hire a certified lead "abate-
ment" contractor. Abatement (or perma-
nent hazard elimination) methods
include removing, sealing, or enclosing
lead -based paint with special materials.
Just painting over the hazard with regular
paint is not permanent removal.
Always hire a person with special training
for correcting lead problems —someone
who knows how to do this work safely and
has the proper equipment to clean up
thoroughly. Certified contractors will employ
qualified workers and follow strict safety
rules as set by their state or by the federal
government.
Once the work is completed, dust cleanup
activities must be repeated until testing
indicates that lead dust levels are below the
following:
40 micrograms per square foot (µg/ft2)
for floors, including carpeted floors;
♦ 250 µg/ft2 for interior windows sills; and
♦ 400 µg/ft2 for window troughs.
Call your state or local agency (see bottom
of page 1 1) for help in locating certified
professionals in your area and to see if
financial assistance is available.
Attachment 11 Page of 16
Remodeling or Renovating a Home With
Lead -Based Paint
Take precautions before your contractor or
you begin remodeling or renovating any-
thing that disturbs painted surfaces (such
as scraping off paint or tearing out walls):
♦ Have the area tested for lead -based
paint.
♦ Do not use a belt -sander, propane
torch, high temperature heat gun, dry
scraper, or dry sandpaper to remove
lead -based paint. These actions create
large amounts of lead dust and fumes.
Lead dust can remain in your home
long after the work is done.
♦ Temporarily move your family (espe-
cially children and pregnant women)
out of the apartment or house until
the work is done and the area is prop-
erly cleaned. If you can't move your
family, at least completely seal off the
work area.
n
u
Follow other safety measures to
reduce lead hazards. You can find out
about other safety measures by calling
1-800-424-LEAD. Ask for the brochure
"Reducing Lead Hazards When
Remodeling Your Home." This brochure
explains what to do before, during,
and after renovations.
If you have already completed renova-
tions or remodeling that could have
released lead -based paint or dust, get
your young children tested and follow
the steps outlined on page 7 of this
brochure.
Attachment 1
Page 12 of 16
If not
conducted
properly,
certain types
of renova-
tions can
release lead
from paint
and dust into
the air.
Other Sources of Lead
While paint, dust,
and soil are the
most common
sources of lead,
other lead
sources also exist.
Drinking water. Your home might have
plumbing with lead or lead solder. Call
your local health department or water
supplier to find out about testing your
water. You cannot see, smell, or taste
lead, and boiling your water will not get
rid of lead. If you think your plumbing
might have lead in it:
• Use only cold water for drinking and
cooking.
• Run water for 15 to 30 seconds
before drinking it, especially if you
have not used your water for a few
hours.
r► The job. If you work with lead, you
could bring it home on your hands or
clothes. Shower and change clothes
before coming home. Launder your work
clothes separately from the rest of your
family's clothes.
Old painted toys and furniture.
Food and liquids stored in lead crystal
or lead -glazed pottery or porcelain.
♦ Lead smelters or other industries that
release lead into the air.
♦ Hobbies that use lead, such as making
pottery or stained glass, or refinishing
furniture.
♦ Folk remedies that contain lead, such as
"greta" and "azarcon" used to treat an
upset stomach.
io Attachment 1
Page 13 of 16
For More Information
The National Lead Information Center
Call 1-800-424-LEAD (424-5323) to learn
how to protect children from lead poisoning
and for other information on lead hazards.
To access lead information via the web, visit
www.epa.gov/iead and
www.hud.gov/offices/lead/.
EPAs Safe Drinking Water Hotline
Call 1-800-426-4791 for information about
lead in drinking water.
Consumer Product Safety
Commission (CPSC) Hotline
To request information on lead in
consumer products, or to report an
unsafe consumer product or a prod- = r
uct-related injury call 1-800-638-
2772, or visit CPSC's Web site at: O
www.cpsc.gov.
Health and Environmental Agencies
Some cities, states, and tribes have
their own rules for lead -based paint
activities. Check with your local agency to
see which laws apply to you. Most agencies
can also provide information on finding a
lead abatement firm in your area, and on
possible sources of financial aid for reducing
lead hazards. Receive up-to-date address
and phone information for your local con-
tacts on the Internet at www.epa.gov/iead
or contact the National Lead Information
Center at 1-800-424-LEAD.
For the hearing impaired, call the Federal Information
Relay Service at 1-800-877-8339 to access any of
the phone numbers in this brochure.
Attachment 1 11
Page 14 of 16
EPA Regional Offices
Your Regional EPA Office can provide further information regard-
ing regulations and lead protection programs.
EPA Regional Offices
Region 1 (Connecticut, Massachusetts,
Maine, New Hampshire, Rhode Island,
Vermont)
Regional Lead Contact
U.S. EPA Region 1
Suite 1100 (CPT)
One Congress Street
Boston, MA 021 14-2023
1 (888) 372-7341
Region 2 (New Jersey, New York,
Puerto Rico, Virgin Islands)
Regional Lead Contact
U.S. EPA Region 2
2890 Woodbridge Avenue
Building 209, Mail Stop 225
Edison, NJ 08837-3679
(732)321-6671
Region 3 (Delaware, Maryland,
Pennsylvania, Virginia, Washington DC,
West Virginia)
Regional Lead Contact
U.S. EPA Region 3 (3WC33)
1650 Arch Street
Philadelphia, PA 19103
(215) 814-5000
Region 4 (Alabama, Florida, Georgia,
Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee)
Regional Lead Contact
U.S. EPA Region 4
61 Forsyth Street, SW
Atlanta, GA 30303
(404)562-8998
Region 6 (Arkansas, Louisiana, New
Mexico, Oklahoma, Texas)
Regional Lead Contact
U.S. EPA Region 6
1445 Ross Avenue, 12th Floor
Dallas, TX 75202-2733
(214)665-7577
Region 7 (Iowa. Kansas, Missouri,
Nebraska)
Regional Lead Contact
U.S. EPA Region 7
(ARTD-RALI)
901 N. 5th Street
Kansas City, KS 66101
(913) 551-7020
Region 8 (Colorado, Montana, North
Dakota, South Dakota, Utah, Wyoming)
Regional Lead Contact
U.S. EPA Region 8
999 18th Street. Suite 500
Denver, CO 80202-2466
(303) 312-6021
Region 9 (Arizona, California, Hawaii,
Nevada)
Regional Lead Contact
U.S. Region 9
75 Hawthorne Street
San Francisco, CA 94105
(415) 947-4164
Region 5 (Illinois, Indiana, Michigan, Region 10 (Alaska, Idaho, Oregon,
Minnesota, Ohio, Wisconsin) Washington)
Regional Lead Contact Regional Lead Contact
U.S. EPA Region 5 (DT-8)) U.S. EPA Region 10
77 West Jackson Boulevard Toxics Section WCM-128
Chicago, IL 60604-3666 1200 Sixth Avenue
(312)886-6003 Seattle, WA 98101-1128
(206) 553-1985
12 Attachment 1
Page 15 of 16
CPSC Regional Offices
Your Regional CPSC Office can provide further information regard-
ing regulations and consumer product safety.
Eastern Regional Center
Western Regional Center
Consumer Product Safety Commission
Consumer Product Safety Commission
201 Varick Street, Room 903
1301 Clay Street, Suite 610-N
New York, NY 10014
Oakland, CA 94612
(212) 620-4120
(510) 637-4050
Central Regional Center
Consumer Product Safety Commission
230 South Dearborn Street, Room 2944
Chicago, IL 60604
(312) 353-8260
HUD Lead Office
Please contact HUD's Office of Healthy Homes and Lead Hazard
Control for information on lead regulations, outreach efforts, and
lead hazard control and research grant programs.
U.S. Department of Housing and Urban Development
Office of Healthy Homes and Lead Hazard Control
451 Seventh Street, SW, P-3206
Washington, DC 20410
(202) 755-1785
This document is in the public domain. It may be reproduced by an individual or
organization without permission. Information provided in this booklet is based
upon current scientific and technical understanding of the issues presented and
is reflective of the jurisdictional boundaries established by the statutes governing
the co-authoring agencies. fallowing the advice given will not necessarily pro-
vide complete protection in all situations or against all health hazards that can
be caused by lead exposure.
U.S. EPA Washington DC 20460 EPA747-K-99-001
U.S. CPSC Washington DC 20207 June 2003
U.S. HUD Washington DC 204in
Attachment 1 (3
Page 16 of 16
Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards
Lead Warning Statement
Housing built before 1978 may contain lead -based paint Lead from paint, paint chips, and dust can pose
health hazards if not managed properly. Lead exposure is especially hamtful to young children and pregnant
women. Before renting pre-1978 housing, lessors must disclose the presence of known lead -based paint and/or
lead -based paint hazards in the dwelling. Lessees must also receive o federally approved pamphlet on lead
poisoning prevention.
Lessor's Disclosure
(a) Presence of lead -based paint and/or lead -based paint hazards (check (1) or (ii) below):
(i) Known lead -based paint and/or lead -based paint hazards are present in the housing
(explain).
Lessor has no knowledge of lead -based paint and/or lead -based paint hazards in the
housing.
(b) Records and reports available to the lessor (check (1) or (ii) below):
(i) Lessor has provided the lessee with all available records and reports pertaining to
lead -based paint and/or lead -based paint hazards in the housing (list documents
below).
Lessor has no reports or records pertaining to lead -based paint and/or lead -based
paint hazards in the housing.
Lessee's Acknowledgment (initial)
(c) Lessee has received copies of all information listed above.
(d) Lessee has received the pamphlet Protect Yourlamilyfrom Lead in Your Home.
Agent's Acknowledgment (initial)
(e) Agent has informed the lessor of the lessors obligations under 42 U.S.C. 4852(d) and
is aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that
the information they have provided is true and accurate.
Lessor Date Lessor Date
Lessee Date Lessee Date
Agent Date Agent Date
Attachment 2 - Page 1 of 2
Disclosure of Information on Lead -Based Paint and/or Lead -Based Paint Hazards
Lead Warning Statement
Every purchaser of any interest in residential real property on which a residential dwelling was built prior to 1978 is
notified that such property may present exposure to lead from lead -based paint that may place young children at risk
Of developing lead poisoning. Lead poisoning in young children may produce permanent neurological damage,
including learning disabllities, reduced intelligence quotient; behavioral problems, and impaired memory. Lead
poisoning also poses a particular risk to pregnant women. The seller of any interest in residential real property is
required to provide the buyer with any information on lead -based paint hazards from risk assessments or inspections
in the seller's possession and notoy the buyer of any known lead -based paint hazards. A risk assessment or inspection
for possible lead -based paint hazards Is recommended prior to purchase.
Seller's Disclosure
(a) Presence of lead -based paint and/or lead -based paint hazards (check (1) or (ii) below):
(i) Known lead -based paint and/or lead -based paint hazards are present in the housing
(explain).
Seller has no knowledge of lead -based paint and/or lead -based paint hazards in the housing.
(b) Records and reports available to the seller (check (i) or (ii) below):
(i) Seller has provided the purchaser with all available records and reports pertaining to lead -
based paint and/or lead -based paint hazards in the housing (list documents below).
(ii) _ Seller has no reports or records pertaining to lead -based paint and/or lead -based paint
hazards in the housing.
Purchaser's Acknowledgment (initial)
(c) Purchaser has received copies of all information listed above.
(d) Purchaser has received the pamphlet Protect Your Family from Lead in Your Home.
(e) Purchaser has (check (1) or (ii) below):
(i) received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assess-
ment or inspection for the presence of lead -based paint and/or lead -based paint hazards; or
waived the opportunity to conduct a risk assessment or inspection for the presence of
lead -based paint and/or lead -based paint hazards.
Agent's Acknowledgment (initial)
(f) Agent has informed the seller of the sellers obligations under 42 U.S.C. 4852(d) and is
aware of his/her responsibility to ensure compliance.
Certification of Accuracy
The following parties have reviewed the information above and certify, to the best of their knowledge, that the
information they have provided is true and accurate.
Seller Date Seller Date
Purchaser Date Purchaser Date
Agent Date Agent Date
(Attachment 2 - Page 2 of 2
Appendix A --Sample Summary Inspection Notice Format
Note: The following appendix will not appear in the code of
Federal Regulations
Summary Notice of Lead -Based Paint Inspection
Address/location of property or structure(s) this summary notice
applies to:
----------------------
-----------------------------------------------------------------------
L----------------------------------------------------------------------
Lead-based paint inspection description:
Date(s) of inspection: -----------------------------------------------
Summary of inspection results (check all that apply):
(a) No lead -based paint was found.
(b) Lead -based paint was found.
(c) _ A brief summary of the findings of the inspection is
provided below (required if lead -based paint found).
Summary of where lead -based paint was found. List at least the
housing unit numbers and common areas (for multifamily housing), and
building components (including type of room or space, and the
material underneath the paint):
C----------------------------------------------------------------------
❑----------------------------------------------------------------------
------
----------------------------------------------------------------------
----------------------------------------------------------------------
-----------------------------------------------------------------------
-'----------------------------------------------------------------------
L�------------------------------------------------------------------
I--------- - -------------------------------------------------------------
---------------------------------------------
:.---------------------------------- ------------------------------------
Contact person for more information about the inspection:
Printed name:--------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
[[Page 502311]
State:_ ZIP: ------------------------------------------------------
Phone number: ( )-------------------------------------------------
Person who prepared this summary notice:
Printed name:--------------------------------------------------------
Signature:-----------------------------------------------------------
Attachment 3
Page ) of 5
Date:--------------------------------------------
--------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
State: ZIP:
Phone number: (_)------------------ --- --
Appendix B--Sample B--Sample Summary Risk Assessment Notice Format
Note: This following appendix will not appear in the Code of
Federal Regulations
Summary Notice of Lead -Based Paint Risk Assessment
Address/location of property or structure(s) this summary notice
applies to:
----------------------------------------------------------------------
-----------------------------------------------------------------------
-----------------------------------------------
------------------------
Lead-based paint risk assessment description:
Date(s) of risk assessment: ------------------------------------------
Summary of risk assessment results (check all that apply):
(a) No lead -based paint hazards were found.
(b) Lead -based paint hazards were found.
(c) A brief summary of the findings of the risk assessment
is provided below (required if any lead -based paint hazards were
found).
Summary of types and locations of lead -based paint hazards. List at
least the housing unit numbers and common areas (for multifamily
housing), bare soil locations, dust -lead locations, and/or building
components (including type of room or space, and the material
underneath the paint), and types of lead -based paint hazards found:
----------------------------------------------------------------------
L----------------------------------------------------------------------
-----------------------------------------------------------------------
L----------------------------------------------
------------------------
I------------------------------
----------------------------------------
L1.-------------------------------------------------------------------------------------------------------------------------------------------
-
Contact person for more information about the risk assessment:
Printed name:--------------------------------------------------------
----------------------------------------------------------------------
Organization:--------------------------------------------------------
----------------------------------------------------------------------
Street and city: -----------------------------------------------------
----------------------------------------------------------------------
State: ZIP: Phone number: (_)---------------------------
Attachment 3
Page 2 of 5
71
-------------------------------------------
---------------
Person who prepared this summary notice:
Printed name:
--------------------------------------------------------
----------------------------------------
----------------
Signature:------------------------------------
-----------------------
Date:
----------------------------------------------------------------
Organization: --------------------------------------------------------
-----------------------------------------------------------------------
Street and city: -----------------------------------------------------
----------------------------------------------------------------------
State: ZIP: Phone number: ( ) ---------------------------
-----------------------------------------------------------------------
Appendix C--Sample Summary Presumption Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations
Notice That Lead -Based Paint or Lead -Based Paint Hazards Are Presumed
to be Present
Address/location of property or structure(s) this notice of
presumption applies to:
-------------------------------------------------------------------
Type of presumption (check all that apply):
(a) Lead -based paint is presumed to be present.
(b) Lead -based paint hazard(s) is(are) presumed to be
present.
Summary of presumption. List at least the housing unit numbers and
common areas (for multifamily housing), bare soil locations, dust -
lead locations, and/or building components (including type of room
or space, and the material underneath the paint), and types of lead -
based paint hazards presumed to be present:
L-----------------------------------------------------------
----------------------------------------------------------
J--------------------------------------------------
7----------------------------------------------------------------------
-----------------------------------------------------------------------
----------------------------------------------------------------------
- ---------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
- ---------------------------------------------------------------------
----------------------------------------------------------------------
L----------------------------------------------------------------------
5----------------------------------------------------------------------
Contact person for more information about the presumption:
Attachment 3
Page 3 of 5
Printed name:
-------------------------------------
-------------------
---------------------------------------
-------------------------------
Organization:--------------------------------------------------------
------------------------
-------------------------------
Street and city -----------------------------------------------------
---------------------------------------------------------------------
State: ZIP: Phone number: (_)---------------------------
❑--------------------
---------------------------
Person who prepared this notice of presumption:
Printed name: --------------------------------------------------------
----------------------------------
-------------------------------------
Signature:-----------------------------------------------------------
Date: ----------------------------------------------------------------
----------------------------------------------------------------------
Organization:--------------------------------------------------------
L'----------------------------------------------------------------------
Street and city: -----------------------------------------------------
----------------------------------------------------------------------
State: ZIP: Phone number: ()---------------------------
L----------------------------------------------------------------------
Appendix D--Sample Hazard Reduction Completion Notice Format
Note: The following appendix will not appear in the Code of
Federal Regulations.
Summary Notice of Completion of Lead -Based Paint Hazard Reduction
Activity
Address/location of property or structure(s) this summary notice
applies to:
-1----------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
Summary of the hazard reduction activity:
Start and completion date(s): ----------------------------------------
Activity locations and types. List at least the housing unit numbers
and common areas (for multifamily housing), bare soil locations,
dust -lead locations, and/or building components (including type of
room or space, and the material underneath the paint), and types of
hazard reduction activities performed at the locations listed:
F----------------------------------------------------------------------
------------------------------------------------------------------
----------------------------------------------------------------------
----------------------------------------------------------------------
-----------------------------------------------------------------------
'-J----------------------------------------------
------------------------
Date(s) of clearance testing and/or soil analyses: _
Locations of building components with lead -based paint remaining in
the rooms, spaces or areas where activities were conducted:
❑----------------------------------------------------------------------
Attachment 3
Page 4 of 5
----------------------------------------------------------------------
J----------------------------------------------------------------------
------------------------------------------------------------------
Summary of results of clearance testing and soil analyses:
(a) No clearance testing was performed.
(b) Clearance testing showed clearance was achieved.
(c) Clearance testing showed clearance was not achieved.
Contact person for more information about the hazard reduction:
Printed name:--------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
State: ZIP: -----------------------------------------------------
Phone number: (_)-------------------------------------------------
Person who prepared this summary notice:
Printed name: --------------------------------------------------------
Signature:-----------------------------------------------------------
Date:----------------------------------------------------------------
Organization:--------------------------------------------------------
Street and city: -----------------------------------------------------
State: ZIP: -----------------------------------------------------
Phone number: ( )-------------------------------------------------
[FR Doc. 99-23016 Filed 9-14-99; 8:45 am]
BILLING CODE 4210-32-P
Attachment 3
Page 5 of 5
ATTACHMENT NO.4
LBP INFORMATION SUMMARY
1. ZERO/O BEDROOM < (LESS THAN) 100 DAYS IN UNIT; ASSISTANCE IN
HOMELESS SHELTER
• STATUS: (; ( 0 PT TIT/ ( ;
2. ZERO/O BEDROOM > (MORE THAN) 100 DAYS IN UNIT
• STATUS: 2 P( 1 ISSU( U1 D( R / BP R( GS
ZERO/O BEDROOM > (MORE THAN) 100 DAYS ASSISTANCE IN
HOMELESS SHELTER
• STATUS: 2 P(1 ISSU( U1 D(R / BP R( GS
• S(( SUBPART.
• C/ (ARA1 C( 2) U1 ITS) WI/ / B( R(QUIR(D B< CIT<) 2 R A/ / H2 U5I1 G U1 ITS
(EVEN ZERO BEDROOM). FOR WHICH OCCUPANCY OCCURS BY ASSISTED
HOUSEHOLD FOR MORE THAN 100 DAYSI PENDING FURTHER
INTERPRETATION/GUIDANCE FROM HUD
P. ONE OR MORE (11-) BEDROOMS OCCUPANCY < 100 DAYS IN
RESIDENTIAL UNIT AND/OR OCCUPANCY IN HOMELESS SHELTER
•(; (OPT TIT/( ;
Q 1HBEDROOMS > 100 DAYS IN RESIDENTIAL UNIT
• STATUS: SAO ( AS #2 AB2 V(; C/ ( ARA1 C( R( QUIR( D
• S( ( SUBPART.
R EMERGENCY RENTAL ASSISTANCE < 100 DAYS
•(;(OPTTIT/( ;
S. EMERGENCY RENTAL ASSISTANCE > TO HOUSEHOLD TO BE
OCCUPANCY IN RESIDENTIAL UNIT FOR MORE THAN 100 DAYS (SUCH AS
LONG TERM LEASE SIGNED AT TIME OF EMERGENCY ASSISTANCE)
Attachment 4
Page 1 of 2
• C/ (ARAI C( B() 2 R( Al Y MONEY DISBURSED;
LBP COMPLIANCEVNOTIFICATIONI EVALUATIONI REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• 0 A< B( C2 1 SID( R( D T( 1 Al T BAS( D R( NTAL ASSISTANCE (TBRA); THUS
HQS INSPECTION AND SUBPART M MAY APPLY
• S( ( SUBPARTS. Al DO
• P( 1 DI1 G HUD GUIDAI C(
T. TB RA < 100 DAYS
-(; (OPT TIT/( ;
U. TBRA > 100 DAYS OF HOME ASSISTANCE (SUCH AS WHEN TENANT
ENTERS INTO LONG TERM LEASE
• S(( SUBPART 0
• C/ (ARAI C( BO 2 R( Al Y MONEY DISBURSED;
LBP COMPLIANCEVNOTIFICATIONI EVALUATIONI REDUCTION THROUGH
CLEARANCE REQUIRED BEFORE OCCUPANCY OF UNIT
• HQS Il SP( CTI2 1 R( QUIR(D BO 2 R( 2 CCUPAI C<
• C/ (ARA1 C( B() 2 R( Al Y MONEY DISBURSED
V. TBRA < 100 DAYS -TENANT ENTERS INTO LONG TERM LEASEI CITY
GIVES LESS THAN 100 DAYS OF ASSISTANCE.
• (; (OPTTIT/( ;
Attachment 4
Page 2 of 2
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Attachment 5
Page 1 of 1
—rv} ,� � j�i !
" �•�.' V f1i0 ISSUE DATE (MMmoNY)
�P
10/31/08
.
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
Alliant Insurance Services, Inc.
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
1301 Dove St., Suite 200
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Newport Beach, CA 92660
(800) 821-9283 Ext. 190. Fax (949) 756-2713
COMPANIES AFFORDING COVERAGE
License No. OC36861
INSURED SPECIAL LIpBILMYINSURANCE PROGRAM PRUP) MEMBER:
COMPANY
ALLIED WORLD NATIONAL ASSURANCE
LETTER A
PAINT YOUR HEART OUT, INC.
COMPANY
1260 N. HANCOCK, UNIT 103
j LETTER 6
ANAHEIM, CA 92807
COMPANY
C
LETTER
� COMPANY
LETTER D
COMPANY
E
LETTER
CONERACrE$
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED
OR MAY PERTAIN, THE INSUR INCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSION AND CONDITIONS OF SUCH POLICIES.
LIMITS__S__H_O_ WN MAY HAVE BEEN REDUCED PAID
_BY_C_LAIMS.
CO - TYPE OFINSURANCE POLICY NUMBER
LTR
POLICY EFFECTIVE —PoLICY
EXPIRATION LIMITS
DATE(MWDDM)
DATE MMIDDYY
A GENERAL
LIABILITY
C0104071001
09/29/08 j 9129/09
GENERALAGGREGATE
NA`
X
COMMERCIAL GENERAL
LIABILITY
I 'I,
PRODUCTS-COMP/OP
$1,000,000
I CLAIMS 1 OCCUR
I MADE
AGO.
PERSONAL & ADV. INJURY
$1,OOD,000
OWNER'S&CONTRACTOR'S
EACH OCCURRENCE
PROT.
!
$1,000,000
X
GLDed: $1,000
FIRE DAMAGE (My ane fie)
$1 000,000
MED. EXPENSE (My one
eraon
_.
N/A
A AUTOMOBILE
LIABILITY
C0104071001
V9129/08 9129/09
$1,000,000
ANY AUTO
1 I
ALL OWNED AUTOS
--.._.__._
BODILY INJURYSCHEDULED
-.._ _..._.__--.-._.-.-.
AUTOS
(Per pePR,n)
dXX
HIRED AUTOSBODILY
INJURY
NON -OWNED AUTOS
(Per acdBaM)
GARAGE LIABILITY
PROPERTY DAMAGE
AUTO DED: $1,000
j
i
EACH OCCURRENCE
UMBRELLA FORM
AGGREGATE
OTHER THAN UMBRELLA FORM
I �'L�
as 61c®a.
+rg � ;
i
STATUTORY LIMIT 6
{ ('1'{Ae
WORKER'S COMPENSATION
I
EACH ACCIDENT
: AND
DISEASE -POLICY LIMIT
j EMPLOYER'S LIABILITY
j
DISEASE -EACH EMPLOYEE
'
I
I
pE cxwr
'POLICY FORM DO[S rvUT I:ONTA�N P GENEAIALiL1tlPLITY gGGREGATE
AS RESPECTS TO THE AGREEMENT WITH THE CITY OF SANTA ANA. THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL
INSURED, THIS INSURANCE IS PRIMARY AND NOT AFFECTED BY ANY OTHER INSURANCE CARRIED BY SUCH ADDITIONAL INSURED WHETHER PRIMARY, EXCESS,
CONTINGENT, OR ON ANY OTHER BASIS, SEVERABILITY OF INTERESTS: THE
TERMS'PARTICIPATING NAMED INSURED" AND "INSURED" ARE USED SEVERALLY AND NOT
COLLECTIVELY, BUT THE INCLUSION HEREIN OF MORE THAN ONE "PARTICIPATING NAMED INSURED' OR "INSURED" SHALL NOT OPERATE TO INCREASE THE LIMITS OF THE
"COMPANY'S" LIABILITY. ADDITIONAL INSURED ENDORSEMENT ATTACHED.
SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS.
CERTIFICATEHOLDER"
E,i��!„;t. Y �. 40";'-w '
< . ,..
.... ,",.
"SHOULD
/.0 ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
'
CITY OF SANTA ANA
IN EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL GNT DGAVGR O MAIL
_
ATTN: FRANK HERNANDEZ
M DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
MANAGEMENT AIDEjJart
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
`EXCEPT 10 DAYS FOU NON-PA4MENT
AU I H RIZED REP ENT
.. NkiIIbiaCii' , nrw. mlalsaalmrL
NIWMpNWAA>+-e »..wmrw>xinRPem -. ewsw+ISPa lam Mn .w .ae,_ay.. u�.rt ,.r>r,an
Endorsement. No. 3
ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION
IT 1S AGREED THAT THE FOLLOWING ARE ADDED AS ADDITIONAL INSURED (S) HEREUNDER BUT
ONLY AS RESPECTS LIABILITY ARISING OUT OF THE OPERATIONS OF THE NAMED INSURED, AND
FURTHER PROVIDED THAT THE INCLUSION OF SUCH ADDITIONAL INSURED SHALL NOT SERVE TO
INCREASE THE COMPANY'S LIMIT OF LIABILITY AS SPECIFIED IN THE DECLARATIONS OF THE
POLICY.
SCHEDULE
NAMED INSURED: PAINT YOUR HEART OUT, INC.
1260 N. HANCOCK, UNIT 103
ANAHEIM, CA 92807
NAME OF PERSON OR
ORGANIZATION/CERTIFICATE HOLDER: CITY OF SANTA ANA
ATTN: FRANK HERNANDEZ
MANAGEMENT AIDE
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS AND EMPLOYEES SHALL BE NAMED ADDITIONAL INSURED FOR
GENERAL LIABILITY AS RESPECTS TO THE AGREEMENT WITH THE CITY OF SANTA ANA, THIS INSURANCE IS
PRIMARY AND NOT AFFECTED BY ANY OTHER INSURANCE CARRIED BY SUCH ADDITIONAL INSURED WHETHER
PRIMARY, EXCESS, CONTINGENT, OR ON ANY OTHER BASIS. SEVERABILITY OF INTERESTS: THE TERMS
"PARTICIPATING NAMED INSURED" AND "INSURED" ARE USED SEVERALLY AND NOT COLLECTIVELY, BUT THE
INCLUSION HEREIN OF MORE THAN ONE "PARTICIPATING NAMED INSURED" OR "INSURED" SHALL NOT OPERATE
TO INCREASE THE LIMITS OF THE "COMPANY'S" LIABILITY.
PER CERTIFICATES OF INSURANCE APPROVED BY THE COMPANY, AND ON FILE WITH THE COMPANY
EFFECTIVE DATE OF THIS ENDORSEMENT: 09/29/08
ATTACHED TO AND FORMING APART OF POLICY NO.: C010407/001
All other terms and conditions remain unchanged.
Insurer: ALLIED WORLD NATIONAL ASSURANCE
Special Liability Insurance Program (SLIP)
Effective September 29, 2008 to September 29, 2009
DATE ISSUED: 10/31/08
CERTHOLDER COPY
SP
STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 03-01-2009 GROUP:
POLICY NUMBER: 1731310-2009
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 03-01-2010
03-01-2009/03-01-2010
CITY OF SANTA ANA SP JOB:ALL CALIFORNIA OPERATIONS
COMM DEV AGENCY M-25 ATTN: FRANK HERNANDEZ
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
- by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be Issued or to which It may pertain, the insurance
afforded by the policy described herein is subject to all the
�terms,
,eexclusions, and conditions, of such policy.
tTHORIZEaD REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
EMPLOYER
PAINT YOUR HEART OUT ANAHEIM, INC AND (A SP
NON-PROFIT CORP)
1280 N HANCOCK ST STE 103
ANAHEIM CA 92807
M0408
(REV.2-05) PRINTED : 02-17-2009